Department of Ultrasound, Peking University People's Hospital, Beijing, China.
Department of Pathology, Peking University People's Hospital, Beijing, China.
J Ultrasound Med. 2022 Mar;41(3):617-626. doi: 10.1002/jum.15740. Epub 2021 May 3.
This study aimed to determine ultrasonic image characteristics that enable differentiation between cholesterol and adenomatous polyps and to assess the diagnostic efficacy of combining conventional ultrasound (CUS) with contrast-enhanced ultrasound (CEUS).
Eighty-nine patients with gallbladder polyps of 1-2 cm in diameter were enrolled and examined by CUS and CEUS before cholecystectomy. The appearances on CUS and CEUS were recorded and analyzed. The receiver operating characteristic (ROC) curve was used to calculate the optimal size threshold for distinguishing cholesterol from adenomatous polyps. A logistic regression analysis was performed to identify diagnostic variables. ROC analysis was performed to evaluate the diagnostic efficacy of the size, the independent variables, and the combined factors.
There were differences in size, number, vascularity on CUS and intralesional vascular shape, wash-out, and area under the curve on CEUS between the two groups (P < .05). ROC analysis indicated that a maximum diameter of 1.45 cm was the optimal threshold for the prediction of adenomatous polyps. The logistic regression analysis proved that the single polyp, presence of vascularity, and intralesional linear vessels were associated with adenomatous polyps (P < .05). ROC analysis showed that the area under the ROC curve, sensitivity, and specificity for the combination of the three independent variables were 0.858, 87.3%, and 67.6%. The number combined with intralesional vascular shape had the highest diagnostic sensitivity of 91.2%.
The combination of CUS and CEUS demonstrated great significance in the differential diagnosis of cholesterol and adenomatous polyps.
本研究旨在确定可区分胆固醇和腺瘤性息肉的超声图像特征，并评估常规超声（CUS）与超声造影（CEUS）联合应用的诊断效能。
在胆囊切除术前行 CUS 和 CEUS 检查，共纳入 89 例直径为 1-2cm 的胆囊息肉患者。记录并分析 CUS 和 CEUS 表现。采用受试者工作特征（ROC）曲线计算鉴别胆固醇与腺瘤性息肉的最佳大小阈值。采用 logistic 回归分析确定诊断变量。ROC 分析评估大小、独立变量和联合因素的诊断效能。
两组在 CUS 上的大小、数量、血管分布以及 CEUS 上的腔内血管形态、洗脱和曲线下面积方面存在差异（P<0.05）。ROC 分析表明，最大直径为 1.45cm 是预测腺瘤性息肉的最佳阈值。logistic 回归分析证实，单发息肉、存在血管分布和腔内线性血管与腺瘤性息肉有关（P<0.05）。ROC 分析显示，联合三个独立变量的 ROC 曲线下面积、敏感度和特异度分别为 0.858、87.3%和 67.6%。将数量与腔内血管形态相结合，具有最高的诊断敏感度（91.2%）。
CUS 和 CEUS 的联合应用在胆固醇和腺瘤性息肉的鉴别诊断中具有重要意义。
